FNP ANCC BOARDS QUESTIONS WITH VERIFIED SOLUTIONS GRADED A+

Dose of Tetanus Immune Globulin (TIG) - CORRECT ANSWER 250 units IM How many doses of Tdap or Td IM needed for protection after clean minor wounds. - CORRECT ANSWER Three doses needed. If 3, unknown, or 10 years since last dose give dose of Tdap or Td for clean minor wounds. No need to give TIG. Non-"clean" minor wounds given both of these if unknown tetanus hx or 3 doses of Tdap/Td. - CORRECT ANSWER Tdap or Td IM & TIG Dirty wounds (puncture, crush injury, soil, saliva, feces, dirt, avulsions, missiles, burns, frostbite) - CORRECT ANSWER If 3 doses Tdap or Td give both Tdap and TIG 250 units. If 3 doses in past, but none in the last 5 years then given Tdap or Td. No need to give TIG If 3 or doses in the past When to switch from DTap to Tdap in children - CORRECT ANSWER Age 7 or given Tdap A woman becomes pregnant and received Tdap during her last pregnancy 1 year ago. When should she receive her next dose. - CORRECT ANSWER Tdap is recommended for each pregnancy. "Getting Tdap between 27 through 36 weeks of pregnancy is 78% more effective at preventing whooping cough in babies younger than 2 months old (CDC)". A person with a hx of anaphylaxis to neomycin should avoid which immunizations (IZ)? - CORRECT ANSWER IPV, MMR, varicella A person with a hx of anaphylaxis to neomycin should avoid which immunizations (IZ)? - CORRECT ANSWER IPV, vaccinia (smallpox) A person with a hx of anaphylaxis to bakers yeast should avoid which immunizations (IZ)? - CORRECT ANSWER Hepatitis B A person with a hx of anaphylaxis to gelatin should avoid which immunizations (IZ)? - CORRECT ANSWER varicella zoster (zostavax) and MMR Epinephrine needs to be on hand for potential anaphylaxis r/t immunization rxn. What other interventions/meds should be considered during anaphylaxis? - CORRECT ANSWER Supine, 911, give epinephrine: 7.5-15kg: give 0.1 mg IM x1 15 to 30 kg: give 0.15mg IM; may repeat in 5-15 min x1 30 kg or Adult: Epipen 0.3mg/0.3mL IM; may repeat in 5-15 min H1/H2 blocker po (diphenhydramine, ranitidine) IV access for fluids, Oxygen. Anticipate ED might give glucagon (if on beta blocker), systemic corticosteroids, bronchodilators s/s anaphylaxis - CORRECT ANSWER Skin: pruritus, urticaria, angioedema Resp: dyspnea, wheezing (bronchospasm), stridor End-organ dysfunction: hypotension, collapse, syncope, incontinence PCV-13 - CORRECT ANSWER Prevnar. Greater protection, Narrower coverage. Pneumococcal conjugate. PCV23 - CORRECT ANSWER lesser protection, broader coverage Which type of vaccine boosts immune response better? conjugate vs. polysaccharide - CORRECT ANSWER conjugate (example: prevnar) Live attenuated (weaned) vaccines - CORRECT ANSWER MMR, Varicella and intranasal Flu-mist. Zostavax is also live. Shingrix is NOT live. When is rotavirus vaccine contraindicated? - CORRECT ANSWER SCID (severe combined immunodeficiency) or hx intussusception Precautions after rotavirus - CORRECT ANSWER hand washing!; viral shed in stool in first week post-vaccination Shingrix: timing and dosing - CORRECT ANSWER =/ 50 y/o, 2 doses, 2nd dose two to six months after 1st dose. Under age 50 y/o gets shingles; think immunocompromise vs. stress. What month does the CDC release a new vaccination schedule each year? - CORRECT ANSWER Feb What s/s are associated with leukemia? - CORRECT ANSWER fever, wt loss, fatigue, bone pain, bleeding, bruising. What bloodwork should be obtained in suspected leukemia? - CORRECT ANSWER WBCs 20,000 (think through common